Glaucoma and intraocular bleeding

Pearls Manager: Andrew Tatham

Either acute bleeding in the anterior chamber or long standing blood in the vitreous of any source can cause IOP elevation. Raised IOP can be caused by normal red blood cells, haemoglobin-laden macrophages (haemolytic glaucoma), or degenerated red blood cells (ghost cell glaucoma). Ghost cells occur one to four weeks after vitreous haemorrhage. Sickle cell disease should always be considered in patients with intraocular bleeding as these patients have higher incidence of elevated IOP. It is recommended to avoid carbonic anhydrase inhibitors and hyperosmotic agents in patients with sickle cell disease.

EGS Guidelines, 4thedition, Page 93.

Reference: Gharaibeh A, Savage HI, Scherer RW, et al. Medical interventions for traumatic hyphema. Cochrane Database Syst Rev 2011(1):CD005431.